ABSTRACT
Background: In the SARS-CoV-2/COVID-19 pandemic, we need to
understand the impact of immunomodulatory medications on COVID-19
symptom severity in patients with inflammatory diseases, including the
Type 2/Th2 polarized skin disease, atopic dermatitis/AD. Since it is
believed that Type 1/Th1immunity controls viral infections, and that
there is a Th1/Th2 counter-regulation, we hypothesized that Th2
targeting with the IL-4Rα-antagonist, dupilumab, in patients with
moderate-to-severe AD rebalances Th1/Th2 axis, potentially leading to
attenuated COVID-19 symptoms.
Methods: 1,237 moderate-to-severe AD patients in the Icahn
School of Medicine at Mount Sinai Department of Dermatology were
enrolled in a registry. Patients were screened for COVID-19-related
symptoms and assigned a severity score
(asymptomatic[0]-fatal[5]). Scores were compared among 3
treatment groups: dupilumab (n=632), other systemic treatments (n=107),
and limited/no treatment (n=498). Demographic and comorbid covariates
were adjusted by multivariate logistic regression models.
Results: The dupilumab-treated group showed reduced incidence
and severity of COVID-19 symptoms versus other treatment groups.
Dupilumab-treated patients were less likely to experience
moderate-to-severe symptoms versus patients on other systemics (p=0.01)
and on limited/no treatment (p=0.04), and less likely to experience any
symptoms versus patients on other systemics (p=0.01). This effect was
seen in our entire cohort and in the subgroup of patients with verified
COVID-19 or high-risk exposure.
Conclusions: Patients on dupilumab experienced less severe
COVID-19 manifestations and lesser symptoms compared to patients on
other systemics and on limited/no treatment. These results suggest that
Th2 modulation with dupilumab may have a protective effect on anti-viral
immune response in AD patients.
Key words: Atopic dermatitis; dupilumab; COVID-19; SARS-CoV-2;
Th2